Lagravere Manuel O, Major Paul W, Flores-Mir Carlos
Orthodontic Graduate Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Angle Orthod. 2005 Nov;75(6):1046-52. doi: 10.1043/0003-3219(2005)75[1046:LSCWRM]2.0.CO;2.
The objective was to evaluate long-term transverse, anteroposterior and vertical skeletal changes after rapid maxillary expansion (RME). The data were clinical trials that assessed skeletal changes through cephalometric analysis. No surgical or other simultaneous treatment during the evaluation period was accepted. Electronic databases (PubMed, Medline, Medline In-Process & Other Non-Indexed Citations, Cochrane Database of Systematic Reviews, ASP Journal Club, DARE, CCTR, Embase, Web of Sciences and Lilacs) were searched with the help of a senior Health Sciences librarian. Abstracts that appeared to fulfill the initial selection criteria were selected by consensus. The original articles were then retrieved. A methodological checklist was used to evaluate the quality of the selected articles. Their references were also hand-searched for possible missing articles. Articles without an adequate control group to factor out growth changes were excluded. Only three articles (one measuring transverse and two anteroposterior and vertical changes) measured RME stability after active expansion, all of them had some methodological flaws, which limit the attainable conclusions. An individual analysis of these articles was made. Long-term transverse skeletal maxillary increase is approximately 25% of the total dental expansion for prepubertal adolescents. Better long-term outcomes are expected in transverse changes because of RME in less skeletally mature patients. RME appears not to produce clinically significant anteroposterior or vertical changes in the position of the maxilla and mandible. The conclusions from this systematic review should be considered with caution because only a secondary level of evidence was found. Long-term randomized clinical trials are needed.
目的是评估快速上颌扩弓（RME）后长期的横向、前后向和垂直向骨骼变化。数据来自通过头影测量分析评估骨骼变化的临床试验。评估期间不接受手术或其他同期治疗。在一位资深健康科学图书馆员的帮助下，检索了电子数据库（PubMed、Medline、Medline在研及其他未索引引文、Cochrane系统评价数据库、ASP期刊俱乐部、DARE、CCTR、Embase、科学网和Lilacs）。通过共识选择了似乎符合初始选择标准的摘要。然后检索原始文章。使用方法学清单评估所选文章的质量。还手动检索了它们的参考文献以查找可能遗漏的文章。排除了没有足够对照组以排除生长变化影响的文章。只有三篇文章（一篇测量横向变化，两篇测量前后向和垂直向变化）测量了主动扩弓后RME的稳定性，所有这些文章都存在一些方法学缺陷，这限制了可得出的结论。对这些文章进行了单独分析。青春期前青少年长期横向骨骼上颌增加量约为总牙齿扩弓量的25%。对于骨骼成熟度较低的患者，由于RME，预计横向变化的长期效果更好。RME似乎不会在上颌骨和下颌骨位置产生临床上显著的前后向或垂直向变化。由于仅发现了二级证据水平，本系统评价的结论应谨慎考虑。需要进行长期随机临床试验。
